Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 516 | CA |
NPI | 1104984764 |
---|---|
Provider Name | Ms. Linda A Johnson |
First Address | Berkeley, CA 94704-2028 |
Second Address | Berkeley, CA 94704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 16/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7550813 | (02) | |
7550813 | (05) | CA |